The aim of this monocentric retrospective work is to compare the brain perfusion methods on their neurological outcome and survival during a type A aortic dissection surgery.

Methods

In this study all patients who underwent an ATAAD surgery between 1987 and 2014 at the Vienna General Hospital were included. During this period 400 patients fulfilled this criterions. 67.5% (n = 270) of the patients were male, 32.5% (n = 130) were female. Of the 400 enrolled patients there were 161 (40.25%) with antegrade cerebral perfusion, of which 104 (64.6%) had an unilateral (u-ACP) and 57 (35.4%) bilateral perfusion (b-ACP). Retrograde cerebral perfusion (RCP) was performed on 117 (29.25%) patients whereby on 109 (27.25%) patients a hypothermic circulatory arrest alone was used.

Results

Both in terms of neurological outcome, as well as on the 6, 12, and 24-month survivor rates, neither the u-ACP nor the b-ACP groups showed statistically significant differences. The overall 30-day mortality was statistically significantly lower at the b-ACP group (p=0,012). Within the antegrade and retrograde perfused patients there were no significant differences.

Conclusion

This study reflects the surgical practice for ATAAD at the general hospital of Vienna in the period from 1987 to 2014. Currently there are no clear recommendations in favour of u-ACP or b-ACP in clinical use. This study shows that the u-ACP and b-ACP lead to similar results. Due to the retrospective character of this study there are many bias influencing the results which is why the present results should be under further review.